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Association of exotoxin-producing group A streptococci and severe disease in children
K Belani1, P M Schlievert, E L Kaplan
1Department of Pediatrics, University of Minnesota Medical School, MN.
Insights
Severe Group A streptococcal infections in children were linked to toxin-producing strains, particularly toxin A. This suggests exotoxins play a key role in severe pediatric streptococcal disease.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Toxicology
Background:
- Group A streptococcal (GAS) infections can range from mild pharyngitis to severe invasive disease.
- The role of GAS exotoxins in severe pediatric infections requires further investigation.
- Previous studies indicated a decline in toxin-producing GAS strains.
Purpose of the Study:
- To analyze clinical and microbiologic data of serious GAS infections in children.
- To investigate the prevalence of toxin-producing GAS strains in severe pediatric cases.
- To compare these strains with community-acquired pharyngeal isolates.
Main Methods:
- Retrospective review of hospitalized pediatric patients with GAS infections (1985-1988).
- Microbiologic analysis of GAS isolates for toxin production (specifically toxin A and B).
- Comparison with concurrently collected community-acquired pharyngeal GAS isolates.
Main Results:
- All 6 hospitalized children with severe GAS infections were caused by toxin-producing strains.
- Four of 6 severe cases involved toxin A-producing strains, not found in 58 community pharyngeal isolates.
- Toxin B production was also more frequent in severe cases than in community isolates.
Conclusions:
- Toxin-producing GAS strains, including toxin A producers, were associated with severe pediatric infections.
- Findings suggest a resurgence of toxin-producing GAS strains in the late 1980s.
- Exotoxins likely contribute significantly to the pathogenesis of severe Group A streptococcal disease in children.
Abstract:
Clinical features and microbiologic data on all cases of serious (hospitalized) Group A streptococcal infections in children managed at our institution between 1985 and 1988 are presented. All 6 cases were caused by toxin-producing strains. Four of 6 were toxin A-producing strains whereas none of 58 community-acquired (Group A streptococcal) pharyngeal isolates in the same period was a toxin A producer. A review of the literature on the incidence of toxin A-producing strains provides information suggesting a resurgence of such strains in the late 1980s after a relative disappearance of toxin B production in isolates from these patients was also significantly greater than in the isolates acquired from the community in uncomplicated pharyngitis. These findings suggest a role for exotoxin in severe manifestations of Group A streptococcal disease in children.